1. Field of the Invention
The invention relates to a device to enable the closure of puncture wounds made by trocars during laparoscopic and other minimally invasive surgical procedures. More specifically, the device relates to a hook shaped device which brings together the edges of the deep tissue layers on opposing sides of a puncture wound by passing a suture through the deep tissue structures, under the skin tissue layer on opposite sides of the wound.
2. Description of the Related Art
It is known to suture puncture wounds such as those formed by trocars during laparoscopic and minimally invasive surgical procedures with a J-shaped needle such as the needle disclosed in U.S. Pat. No. 5,336,239. A J-shaped needle may be used to pass a suture through the deep tissue layers on opposing sides of a puncture wound such as the peritoneal membrane and deep abdominal fascia punctured during laparoscopic abdominal surgery. The point of the J-shaped needle may be covered as the needle is inserted into the puncture wound. The needle is then exposed from the cover and drawn outward through the subcutaneous tissue layers and finally through the skin on a side of the wound. The surgeon then threads a length of suture through the eye of the needle and draws the needle back through the skin and tissue into the body. The needle is passed out of the body through the tissue at another location on an opposite side of the wound completing the suture. This process is repeated as necessary to close the wound.
One of the disadvantages of the devices of the prior art such as the one disclosed in U.S. Pat. No. 5,336,239, is that, in order to be insertable through a trocar cannula, the needle profile has to be equal to or less than the internal diameter of the trocar cannula. For example, in currently available devices, if the internal diameter of the trocar cannula is 10 mm, then the width of the J-shaped needle measured from the widest point on the outside of the short leg of the "J", to the outside of the long leg of the "J" must be equal to or less than 10 mm. With this restriction the amount of "bite" that the prior art device can achieve (i.e., the amount of tissue it can capture for suturing) is limited to the maximum gap between the two legs of the "J" shaped needle. This is an unwanted limitation on the ability to secure the tissue under certain circumstances.
Examples of J-shaped needles are disclosed in commonly-owned U.S. patent application Ser. Nos. 08/134,561 and 08/145,855 now U.S. Pat. Nos. 5,468,251 and 5,439,469 respectively. One embodiment of such needles is shown in FIGS. 1A and 1B. The needle 10 is housed in a cylindrical guide member 12 during insertion of the needle into a patient. After insertion, the needle 10 is rotated 180 degrees with respect to the guide member 12 about an axis x of the longer leg of the needle. As shown in phantom lines in FIGS. 1A and 1B, the short leg 16 of J-shaped needle 10 when rotated 180 degrees is positioned at a distance (a) from the guide member 12. The distance (a) is less than the diameter (b) of the guide member 12. As a result, the amount of tissue which can be captured between the short leg 16 and the housing 12 is rather limited.
Other types of needle arrangements are disclosed in WO93/21831, WO92/12674, EP 589409 A1, EP 568098 A2 and U.S. Pat. Nos. 5,222,508, 5,281,237, 5,350,385 and 5,320,632.